TN 13 (09-15)
DI 23022.820 Medulloblastoma
COMPASSIONATE ALLOWANCE INFORMATION
Medulloblastoma is a rare type of malignant brain cancer that occurs in the cerebellum and adjacent tissue (which control body movement and coordination). Medulloblastomas are primarily a type of childhood brain cancer, and rarely occur in adults.
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Diagnostic testing: Imaging tests include MRI, CT, and radionuclide bone scans. A spinal tap may be performed to obtain cerebral spinal fluid to search for cancer cells or tumor markers. Analysis of the tumor after surgical resection confirms the diagnosis of medulloblastoma.
ONSET AND PROGRESSION
Prognosis is poor for medulloblastoma.
Surgery alone does not cure this type of cancer. Chemotherapy and radiation are often used in combination with surgery.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for evaluation:
Pathology report of biopsy findings.
If a pathology report is unavailable, a surgical report or all radiological studies (for example, MRI and CT scans) and treatment notes indicating antineoplastic therapy for metastases may be substituted.
If available, spinal tap results.
Suggested Listings for Evaluation:
Medulloblastoma meets 13.13A2 and 113.13B upon confirmed diagnosis, regardless of the effectiveness of treatment.
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.